NPIMap

Organization Active NPI

Sunbridge Retirement Care Associates LLC

Doing business as Fayetteville Care and Rehabilitation Center

  • Skilled Nursing Facility
  • Fayetteville, TN
National Provider Identifier
1801843313
Registry record updated Aug 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0000000305 Issued in TN
Legal business name
SUNBRIDGE RETIREMENT CARE ASSOCIATES LLC
Doing business as
Fayetteville Care and Rehabilitation Center
Practice address
4081 Thornton Taylor Pkwy
Fayetteville, TN 37334-2674
Phone
(931) 433-9973
Fax
(931) 433-4693
NPI assigned
May 28, 2006
Last updated
Aug 17, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
SUNBRIDGE HEALTHCARE CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
William A. Mathies
Title
President Director
Phone
(505) 468-5013

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0000000305 TN Primary

Addresses

Primary practice location

4081 Thornton Taylor Pkwy
Fayetteville, TN 37334-2674

Mailing address

101 Sun Ave NE
Compliance Department
Albuquerque, NM 87109-4373
Phone (505) 468-5604

Other identifiers 4

IdentifierTypeStateIssuer
0445320MedicaidTN
445320OtherAARP
#3033966OtherTNBLUE CROSS/BLUE SHIELD OF
7440356MedicaidTN

Other names 1

  • Fayetteville Care and Rehabilitation Center Doing business as

National Provider Directory

National Provider Directory
Part of
Sunrise HLTH Care Corp

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534464000000",
    "number": "1801843313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SUN AVE NE",
            "address_2": "COMPLIANCE DEPARTMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094373",
            "telephone_number": "505-468-5604",
            "fax_number": "505-468-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4081 THORNTON TAYLOR PKWY",
            "city": "FAYETTEVILLE",
            "state": "TN",
            "postal_code": "373342674",
            "telephone_number": "931-433-9973",
            "fax_number": "931-433-4693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNBRIDGE RETIREMENT CARE ASSOCIATES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNBRIDGE HEALTHCARE CORPORATION",
        "enumeration_date": "2006-05-28",
        "last_updated": "2018-08-17",
        "status": "A",
        "authorized_official_last_name": "MATHIES",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT DIRECTOR",
        "authorized_official_telephone_number": "505-468-5013"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": "0000000305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0445320",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AARP",
            "identifier": "445320",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD OF",
            "identifier": "#3033966",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7440356",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fayetteville Care and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.